The effect of a simulation-based training intervention on the performance of established critical care unit teams

Abstract

OBJECTIVE: We evaluated the effectiveness of a simulation-based intervention on improving teamwork in multidisciplinary critical care teams managing airway and cardiac crises and compared simulation-based learning and case-based learning on scores for performance. DESIGN: Self-controlled randomized crossover study design with blinded assessors. SETTING: A simulated critical care ward, using a high-fidelity patient simulator, in a university simulation center. SUBJECTS: Forty teams from critical care units within the region comprising one doctor and three nurses. INTERVENTION: At the beginning and end of the 10-hr study day, each team undertook two preintervention and two postintervention assessment simulations (one airway, one cardiac on both occasions). The study day included presentations and discussions on human factors and crisis management, and airway and cardiac skills stations. For the intervention, teams were randomized to case-based learning or simulation-based learning for cardiac or airway scenarios. MEASUREMENTS AND MAIN RESULTS: Each simulation was recorded and independently rated by three blinded expert assessors using a structured rating tool with technical and behavioral components. Participants were surveyed 3 months later. We demonstrated significant improvements in scores for overall teamwork (p ≤ .002) and the two behavioral factors, "Leadership and Team Coordination" (p ≤ .002) and "Verbalizing Situational Information" (p ≤ .02). Scores for clinical management also improved significantly (p ≤ .003). We found no significant difference between simulation-based learning and case-based learning in the context of this study. Survey data supported the effectiveness of study day with responders reporting retention of learning and changes made to patient management. CONCLUSIONS: A simulation-based study day can improve teamwork in multidisciplinary critical care unit teams as measured in pre- and postcourse simulations with some evidence of subsequent changes to patient management. In the context of a full-day course, using a mix of simulation-based learning and case-based learnings seems to be an effective teaching strategy.